Healthcare Provider Details

I. General information

NPI: 1356341671
Provider Name (Legal Business Name): ROBERT FRANCISCO LETAMENDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BRENNAN ST SUITE 21
WATSONVILLE CA
95076-4337
US

IV. Provider business mailing address

21 BRENNAN ST SUITE 21
WATSONVILLE CA
95076-4337
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-4030
  • Fax: 831-728-3205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA50002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: